Cracking the Code for Quality: The Interrelationships of Culture, Nurse Demographics, Advocacy, and Patient Outcomes.

OBJECTIVE: The aim of this study was to describe the complex relationships among patient safety culture, nurse demographics, advocacy, and patient outcomes. BACKGROUND: Why has healthcare lagged behind other industries in improving quality? Little nursing research exists that explores the multifactorial relationships that impact quality. METHODS: A convenience sample of 1045 nurses from 40 medical/surgical units was analyzed using a correlational cross-sectional design with secondary data analysis. Data sources included survey results for patient safety culture, nurse perceptions of patient advocacy, and patient experience and fall and pressure ulcer rates. RESULTS: Significant findings included a positive correlation between patient safety culture and advocacy and a negative correlation between safety culture, advocacy, and years of experience as a nurse. No significant correlations were found between safety culture and patient outcomes or advocacy and patient outcomes. CONCLUSIONS: Newer nurses were more positive about safety culture and advocacy, whereas experienced nurses were overall less positive.

Nurturing innovation in the critical care environment: transforming care at the bedside.

By their sheer nature, critical care nurses are innovative and adaptable problem solvers. The Transforming Care at the Bedside (TCAB) project is a vehicle to create solutions when problems are identified. The TCAB project engages front-line staff to identify areas for improvement and develop solutions. The adoption of TCAB principles into the critical care environment was a natural progression in the development of the innovative culture at the UPMC Shadyside.

Why do nurse managers stay? Building a model of engagement: part 2, cultures of engagement.

The short tenure of nurse managers is an urgent aspect of the leadership vacuum within the nursing shortage. The authors, who sought to build a model of nurse manager engagement in contrast to a retention model, continue to report data from a national qualitative study funded by The Robert Wood Johnson Foundation of 30 outstanding and longtime nurse managers in 6 settings. Part 1 (March 2008) described the dimensions and applications of individual engagement. In this article (part 2), the authors describe the organizational factors that contribute to engagement for nurse managers and the applications for building cultures of engagement.

Magnet recognition program: the next generation.

Twenty-five years ago, the foundation of the Magnet Recognition Program was established. Magnet designation has served as the hallmark of excellence for nursing practice, and research has demonstrated a profound impact on nursing practice and patient care. The purpose of this article was to forecast the direction of the Magnet Recognition Program. The authors discussed the results of a multivariate structural analysis of the forces of magnet and the subsequent future model for Magnet.

Why do nurse managers stay? Building a model of engagement: part 1, dimensions of engagement.

The short tenure of nurse managers suggests the urgent need for a new model to understand and build engagement that translates into longevity and excellence in nurse managers. The authors report data from a national qualitative study, funded by the Robert Wood Johnson Foundation, of 30 outstanding long-time nurse managers in 6 settings and offer patterns of individual and cultural elements linked to engagement. Part 1 describes the dimensions of individual engagement along with the implications for developing and sustaining nurse managers. In Part 2, which will be available in April 2008, the authors will give details on the organizational factors that contribute to engagement of nurse managers and the applications for building cultures of engagement.

Evaluation of the Magnet Recognition Program.

Launched in the early 1980s, Magnet Recognition has been the focus of nurse administrators for over 2 decades in their quest for excellence in nursing practice and outcomes of patient care. The authors describe a comprehensive evaluation of the appraisal process within the Magnet Recognition Program commissioned by the American Nurses Credentialing Center and discusses recommendations for change in the program.

Improving patient satisfaction through multidisciplinary performance improvement teams.

Hospitals today are challenged by high patient census, rising acuity, and workforce issues that can result in a serious decline in overall patient satisfaction. This article discusses how one hospital tackled the issue of declining patient satisfaction scores on five "troubled" patient care units through a performance improvement strategy that included MD-RN partnerships, co-mentoring, and unit staff development and involvement in the problem-solving process. The result was a steady improvement in patient satisfaction over a 6-month period.